Trousseau综合征致多发性脑梗死的临床及MRI特点分析

Clinical and MRI Characteristics of Trousseau Syndrome with Multiple Cerebral Infarctions

目的探讨Trousseau综合征致多发性脑梗死的临床及MRI特点,提高对本病的诊断准确性。方法回顾性分析17例Trousseau综合征致多发性脑梗死病例,全面分析其临床及MRI特点。结果17例患者中,原发肿瘤以肺癌常见,D-二聚体平均水平明显升高。MRI表现均累及多支动脉供血区的多发脑梗死,双侧前循环加后循环16例,双侧前循环1例;病灶累及大脑皮层及皮层下、大脑深部及小脑半球13例,大脑皮层及皮层下、小脑半球3例,大脑深部1例。梗死灶≥30个12例,梗死灶>10个、<30个4例,梗死灶<10个1例,其中小梗死灶5例,小、中梗死灶共存9例,小、中、大梗死灶共存3例。DWI上均表现为高信号,ADC图上表现低信号和等信号共存12例(急性和亚急性期脑梗死),低信号4例(急性期脑梗死),等信号1例(亚急性期脑梗死)。增强扫描8例,其中6例梗死灶出现强化,点片状均匀强化4例,线状强化1例,斑片状强化1例。16例脑动脉未见有意义狭窄,1例右侧大脑中动脉闭塞。结论Trousseau综合征致多发性脑梗死的MRI表现具有一定特征性,结合D-二聚体指标,可提高诊断的准确性。

Objective To investigate the clinical and MRI characteristics of multiple cerebral infarction patients with Trousseau syndrome,and improve diagnostic accuracy.Methods 17 cases of Trousseau syndrome with multiple cerebral infarctions were retrospectively reviewed,and the MR images and clinical information were comprehensively analyzed.Results Among the 17 patients,the primary tumor was lung cancer,and the average level D-dimer was significantly elevated.MRI findings were multiple cerebral infarctions involving the blood supply area of multiple arteries,including 16 cases of bilateral anterior circulation plus posterior circulation,one case of bilateral anterior circulation;lesions involving the cerebral cortex and subcortical,deep brain and cerebellar hemispheres in 13 cases,cerebral cortex and 3 cases were subcortical and cerebellar hemispheres,and one case was deep brain.The amounts of infarcts lesion occurred more than 30 in 12 cases,more than 10 and less than 30 in 4 cases,less than 10 in 1 case.The small infarcts,small and medium infarcts,and small,medium and large infarcts were observed in 5 cases,9 cases and 3 cases,respectively.All of the cerebral infarction show hyperintense on DWI,while on ADC imaging,12 cases with hypointense and isointensity signal(acute and subacute cerebral infarction),4 cases with hypointense(acute cerebral infarction)and one case with isointensity(subacute cerebral infarction).Among 8 cases underwent a contrasted-enhancement scan,6 cases cerebral infarction manifested enhancement,including spot film and homogeneous enhancement in 4 cases,linear enhancement in one case,and patchy enhancement in one case.Furthermore,16 cases of cerebral artery not occurred stenosis while one case associated with right middle cerebral artery occlusion.Conclusion MRI features of multiple cerebral infarctions by Trousseau syndrome have typical characteristics,once combined with D-Dimer indicators,which could improve the accuracy of diagnosis.